Comparison of utilization of statin therapy at hospital discharge and six-month outcomes in patients with an acute coronary syndrome and serum low-density lipoprotein>or=100 mg/dl versus<100 mg/dl.

The use of, factors associated with, and long-term outcomes related to statin therapy in patients with acute coronary syndromes and low-density lipoprotein (LDL) levels<100 mg/dl at the time of hospital presentation are unclear. This report describes the use of statins at hospital discharge in 8,492 patients with acute coronary syndromes enrolled in the Global Registry of Acute Coronary Events (GRACE; 1999 to 2005) according to baseline LDL levels (<100 vs>or=100 mg/dl) and compares 6-month outcomes in each group stratified by the use or nonuse of statin therapy. Seventy-two percent of patients with LDL levels>or=100 mg/dl, compared with 55% of patients with LDL levels<100 mg/dl, were discharged on statin therapy.

Differences between local hospital and core laboratory interpretation of the admission electrocardiogram in patients with acute coronary syndromes and their relation to outcome.

In the prospective, multinational Global Registry of Acute Coronary Events (GRACE), patients diagnosed with non-ST-elevation acute coronary syndromes had their admission electrocardiogram independently evaluated by a central core laboratory, and its interpretation by the core laboratory and enrolling site were compared. One in 6 of these patients had clinically important features of left-bundle branch block or ST-segment deviation diagnosed by the core laboratory that were apparently not recognized at the local sites; this subgroup of patients was less likely to undergo risk stratification and revascularization. Importantly, failure to recognize these features as confirmed by the core laboratory in routine clinical practice was independently associated with higher mortality and recurrent myocardial infarction at 6 months (adjusted odds ratio 1.

Impact of prior peripheral arterial disease and stroke on outcomes of acute coronary syndromes and effect of evidence-based therapies (from the Global Registry of Acute Coronary Events).

We assessed the effect of previous peripheral arterial disease (PAD) and stroke on clinical outcomes in patients with acute coronary syndrome (ACS) and sought to ascertain the effectiveness of evidence-based therapies in these patients. We used data from the multinational Global Registry of Acute Coronary Events. Patients were enrolled at 102 hospitals in 13 countries between April 1999 and September 2005.

Relationship of ST elevation in lead aVR with angiographic findings and outcome in non-ST elevation acute coronary syndromes.

Background: Limited data suggest that ST elevation (ST elevation) in aVR is associated with higher mortality and more extensive coronary artery disease in the setting of non-ST elevation acute coronary syndromes (ACS).

Methods: In the prospective Global Registry of Acute Coronary Events (GRACE) electrocardiographic substudy, the admission electrocardiograms were analyzed by a blinded core laboratory. We performed multivariable analysis to determine (1) the independent prognostic significance of ST elevation in aVR and (2) its association with significant (> or = 50% stenosis) left main or 3-vessel disease (LM/3-vd).

Combining warfarin and antiplatelet therapy after coronary stenting in the Global Registry of Acute Coronary Events: is it safe and effective to use just one antiplatelet agent?

Aims: To identify factors associated with the use of single or dual antiplatelet therapy in patients prescribed warfarin following coronary stenting and to investigate whether single (aspirin or thienopyridine) vs. dual antiplatelet therapy plus warfarin leads to an excess of adverse outcomes.

Methods And Results: We analysed data from 800 patients with an acute coronary syndrome who underwent coronary stenting (130 patients received a drug-eluting stent) and were discharged on warfarin and either dual (n = 580) or single (n = 220) antiplatelet therapy.

Predicting coronary artery bypass graft surgery in acute coronary syndromes.

Aims: To identify features predictive of hospital coronary artery bypass graft (CABG) surgery in patients with acute coronary syndromes (ACSs).

Methods And Results: Data from 17,434 patients enrolled in an observational study were analysed. Patients in private hospitals were more likely to undergo CABG than those in public hospitals (10.

External validity of clinical trials in acute myocardial infarction.

Background: Patients enrolled in randomized clinical trials (RCTs) may not reflect those seen in real-life practice. Our goal was to compare patients eligible for enrollment but not enrolled in contemporary RCTs of reperfusion therapy with patients who would have been ineligible and also with patients with acute myocardial infarction (AMI) participating in RCTs.

Methods: Consecutive patients with AMI (n = 8469) enrolled in the GRACE registry (Global Registry of Acute Coronary Events) were divided into 3 groups: RCT participants (11%; n = 953), eligible nonenrolled patients (55%; n = 4669), and ineligible patients (34%; n = 2847).

Use of heparins in Non-ST-elevation acute coronary syndromes.

Purpose: We describe the use of antithrombotic therapy in the management of patients with acute coronary syndromes.

Methods: Patients from the Global Registry of Acute Coronary Events, a multinational coronary disease registry, were characterized according to the early and continued use of low-molecular-weight heparin, unfractionated heparin, any crossover of heparin therapy (change in early vs late heparin treatment), and no heparin treatment. Hospital outcomes were analyzed according to the heparin treatment and the timing of percutaneous coronary interventions.

Association of peripheral artery disease with treatment and outcomes in acute coronary syndromes. The Global Registry of Acute Coronary Events (GRACE).

Background: National guidelines recommend the use of secondary prevention modalities for patients with peripheral artery disease (PAD) and coronary artery disease. The effect of prior PAD on the treatment and outcomes of patients with acute coronary syndromes (ACS), however, is not well characterized. The objectives of this study were to assess treatment practices and hospital outcomes in patients with ACS and prior PAD.

The diagnostic and prognostic impact of the redefinition of acute myocardial infarction: lessons from the Global Registry of Acute Coronary Events (GRACE).

Background: The impact and prognostic value of the redefinition of myocardial infarction (MI) with more sensitive markers have not been evaluated prospectively in a large, less selected population with acute coronary syndrome (ACS).

Methods: We evaluated the attack and case-fatality rates of MI based on initial and/or peak creatine kinase (CK), creatine kinase-MB (CK-MB), and cardiac troponin (the upper limit of normal [ULN] was defined according to the local hospital's standard) in a prospective observational registry of 26,267 patients with ACS admitted to 106 hospitals in 14 countries.

Results: The addition of cardiac troponin-positive status to CK status as a criterion for the diagnosis of MI resulted in as many as 1 in 4 additional patients meeting the redefined criteria.

Medication performance measures and mortality following acute coronary syndromes.

Purpose: To identify patient and health care factors which are related to the use of medical treatments that comprise quality measures and to assess the relation of these measures with mortality.

Methods: The study sample consisted of 20 140 patients with acute coronary syndromes from the international GRACE registry. Multivariable logistic regression modeling was used to determine predictors of quality performance.

Association of statin therapy with outcomes of acute coronary syndromes: the GRACE study.

Background: Statins administered early in patients with acute coronary syndromes may lead to modest reductions in recurrent ischemic events.

Objective: To examine the association between previous and early in-hospital statin therapy and the presentation and outcomes of an acute coronary syndrome.

Design: Cohort study.

Effectiveness of primary percutaneous coronary intervention compared with that of thrombolytic therapy in elderly patients with acute myocardial infarction.

Background: Few data exist from a community-based perspective on the relative effectiveness of primary percutaneous coronary intervention (PCI) as compared with thrombolytic therapy (TT) in elderly patients with ST-elevation myocardial infarction (STEMI), particularly in the current era of coronary stents and newer antithrombotic agents.

Methods: We evaluated data from patients, aged > or =70 years, with STEMI who were enrolled in the Global Registry of Acute Coronary Events study between April 1999, and September 2002.

Results: Of the 2975 elderly patients eligible for reperfusion therapy, 365 (12.